If, as some researchers maintain, roughly 10% of hip arthroplasty patients are not satisfied with their new hip, then, hypothesized a research group from the Department of Orthopaedic Surgery at Kanazawa University in Japan, gait speed might offer a clue as to causes of poor hip outcomes.
Wow! Non-Op Hip Health Drives Post-Op Hip Outcomes
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#totalhiparthroplastySecondary#contralaterallowerlimb#gaitspeed
Their work, “Contralateral Lower-Limb Functional Status Before Total Hip Arthroplasty: An Important Indicator for Postoperative Gait Speed,” appears in the June 16, 2021 edition of The Journal of Bone and Journal Surgery.
In this prospective case control study, investigators reviewed pre- and postop computed tomographic (CT) images for each of 91 patients with hip osteoarthritis (OA). They transferred this imaging data to a CT-based 3D templating system and built 3-dimensional models of the pelvis and femur. According to the authors, the templating system, “ZedHip can be used to perform a virtual THA [total hip arthroplasty] and allows matching of the position of both femora (varus and valgus, flexion and extension, and internal rotation and external rotation) with the pelvis…”
The researchers used the 1-leg standing time and knee extensor strength of both the treated and the contralateral sides; the functional reach tests were examined preoperatively and at one year postop. Patients underwent either the posterior or the anterolateral approach.
Co-author Tamon Kabata, M.D., Ph.D. told OTW, “The most important result of this study was that preoperative non-operated side lower limb function status were significant factors for postoperative gait speed after THA. In particular, a preoperative comfortable gait speed of ≥1.115 m/s was required for a good postoperative outcome.”
Decision making tool?
“We think that early surgical intervention before the non-operated side function declines or preoperative rehabilitation intervention on the non-operated side may improve THA outcome. This is a very important finding in determining the indication for surgical intervention. We think it can be one indicator for patients who are not sure whether to undergo THA.”
React:
Discussion
This is a fascinating development. In my practice we've seen similar outcomes with the revised protocol. The key differentiator seems to be patient selection criteria. Has anyone else noticed the correlation with BMI thresholds?
Great point. I'd push back slightly on the conclusion, the sample size in the cited study is too small to draw population-level inferences. That said, the directional signal is compelling and worth a larger RCT.
We implemented a similar approach last year. Early results are promising but we're still gathering 12-month follow-up data. Happy to share our protocol if anyone is interested.
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